Introduction: The National Disability Insurance Scheme (NDIS) is the catalyst for a significant shift in the delivery of disability services to people with a disability and their families, including those residing in rural and remote parts of Australia. Allied health services in rural areas of Australia are often limited, and existing services are characterised as being of a generalist nature and demand for services often exceeds service capacity. This shift in the delivery of disability services that has occurred with the roll-out of NDIS could have a poignant impact on those rural based allied health providers delivering these services. We aimed to explore in-depth the experiences of providing clinical services under the NDIS in a rural area.
Method: Accessing the publicly-available NDIS register, we purposively sampled service providers delivering services in rural or remote areas of NSW. Participants consented via email to participate in a semi-structured interview during which we asked about their lived experience providing services under the NDIS in rural NSW. Data collection and analysis was guided by phenomenology of practice. Interviews were audio recorded and transcribed verbatim, and data were then thematically analysed.
Results: Eight service providers were interviewed representing the disciplines of occupational therapy, nutrition and dietetics, speech pathology and physiotherapy. The location of their service delivery varied across a range of rural and remote areas of NSW. Data analysis yielded three themes: (1) Beyond My Depth, which described service providers’ limited influence on the funding process their clients were now required to navigate as participants of the NDIS. (2) A Sea of Uncertainty, which described the inconsistencies demonstrated by the NDIS and its impact on service providers. (3) Drowning in the Wave, which described increases in service demand and changes to casemix as experienced by service providers. Finally, the essence of the phenomenon of providing services within the NDIS in a rural area was identified as Powerless Facing the Wave of Change.
Conclusion: These findings offer insights into the particular challenges for rural clinicians in providing services under the NDIS. While there is improved funding support for people with a disability, this placed additional pressure on rural clinicians who were already likely to be working at or beyond their workload capacity. Issues with recruitment and retention of new clinicians into rural and remote areas appear to be ongoing which was identified to compound the impact of the NDIS on existing service providers. Supporting the rural and remote workforce appears critical to avoid de-registration of existing NDIS service providers.